and transplant clinic setup” (Chapter 3).
Ideally, the core team, including physician assistants, nurse practitioners, social workers, physiologist, nutritionist, physical assistants/therapists and a coordinating team should be directly or indirectly involved in the preparation and implementation of the LTFU visit. The role of each member of the core team should be defined before the visit, to ensure that essential issues of the visit are not forgotten or are discussed repeatedly, for example, sexuality, financial toxicity, or occupational status. For specialized examinations and managements, subspecialists such as gynecologist, dermatologist, dentist, ophthalmologist, or endocrinologist should be involved. Such consultations, as well as particular examinations such as imaging procedure, lung function tests, bone density scans, or cardiologic investigations, have to be scheduled carefully for the visit.
After the visit, all clinical and biologic information obtained should be available. The follow‐up visit will be summarized in a single, structured document. This document is a useful tool for the primary healthcare provider, as well as for the LTFU clinic.
Screening and preventive recommendations
Recommendations on screening and preventive practices for long‐term survivors after HSCT have been published in 2006 [7], and updated in 2012 [4]. A list of the recommended screening and preventive practices for long‐term survivors after HSCT has been adapted from these publications [6]. This list includes most of the examinations and tests to be considered during the LTFU visit, and covers most of the known complications that may occur after HSCT (Table 5.3).
Table 5.3 Summary of recommendations for screening and prevention of late complications in long‐term survivors after HSCT
(Source: Adapted from Majhail [4] and Majhail and Hashmi [6].
| Recommended screening/prevention | 6 months | 1 year | Annually |
|---|---|---|---|
| Immunity | |||
| Encapsulated organism prophylaxis | 2 | 2 | 2 |
| PCP prophylaxis | 1 | 2 | 2 |
| CMV testing | 2 | 2 | 2 |
| Immunizations | 1 | 1 | 1 |
| Ocular | |||
| Ocular clinical symptom evaluation | 1 | 1 | 1 |
| Ocular fundus examination | + | 1 | + |
| Ocular examination by an expert | + | 1 | + |
| Oral | |||
| Clinical assessment | 1 | 1 | 1 |
| Dental assessment | + | 1 | 1 |
| Oral assessment by an expert | + | + | + |
| Respiratory | |||
| Clinical pulmonary assessment | 1 | 1 | 1 |
| Smoking tabaco avoidance | 1 | 1 | 1 |
| Pulmonary function testing | + | + | + |
| Chest imaging procedures | + | + | + |
| Cardiac and vascular | |||
| Cardiovascular risk factor assessment | + | 1 | 1 |
| Extended cardiac assessment by an expert | + | + | + |
| Liver | |||
| Liver function testing | 1 | 1 | 1 |
| Serum ferritin testing | 1 | + | |
| Additional diagnostic testing if indicated (liver biopsy, MRI) | + | + | + |
| Kidney | |||
| Blood pressure screening | 1 | 1 | 1 |
| Urine protein screening | 1 | 1 | 1 |
| BUN/creatinine testing | 1 | 1 | 1 |
| Further workup if clinically indicated |
|
